Dr. Rushton proposes a career award to study and improve the diagnosis and treatment of children and adolescents with depressive disorders by primary care physicians. Recent changes in health care have important implications for management of depression including primary care gatekeeping, limited access to mental health providers and counseling, and new antidepressants. Yet, little information exists on the current role of primary care physicians, or how these physicians can improve coordination of care and services to improve patient outcomes. Dr. Rushton plans two phases of research to address his aims using complementary methods: (1) analysis of health system administrative data, (2) survey of primary care physicians. The proposed studies will describe depressed children and adolescents and their health care utilization; define the scope of primary care and relationships to mental health providers; analyze variations in prescriptions, referrals, and management of depressed youth; and examine influences on physician triage and treatment decisions. This research will be accomplished over five years and incorporate coursework and training in survey techniques (quantitative and qualitative), statistical analysis, pharmacology, child and adolescent psychiatry, and health services research. In the final years of the grant period, Dr. Rushton will develop a grant proposal based on his findings to design interventions to improve the quality of mental health services and integrate primary care with specialty and community providers. The University of Michigan provides the clinical and research environment to accomplish the proposed aims and career goals with support from many disciplines led by co-mentors, Dr. Gary Freed (Pediatric Health Services Research) and Dr. John Greden (Psychiatry). The candidate will acquire skills and connections that will allow him to become an independent researcher working at the important interface of delivery systems. The proposed research will set the stage for additional mental health services for children, quality improvement interventions on prescriber practices, and health system efforts to coordinate mental health services with primary care.